Post-Deployment Stress:
Helping Veterans and
Their Families
to do the opposite of what would otherwise
come naturally: substituting rage for terror,
submission to authority for the right to know
what is going on, a cool and detached
silence instead of confronting, running or
weeping.
For most, if not all, returning soldiers, there
will be emotional aftermath ranging from
mild Adjustment problems (e.g., trouble
sleeping in a bed, impatience in the absence
of reliable routines and orderliness in home
or work environments), to Traumatic Grief
Reactions and Anxiety, to Major Depressive
and Post-Traumatic Stress Disorders
(PTSD). In the case of PTSD, symptoms
often do not emerge for 3-6 months or only
after a secondary trauma (e.g., an accident or
car crash) occurs.
According to a large scale study of veterans
deployed between 2001 and 2005, at least
18% have developed PTSD or Major
Depression; 19.5% suffer from traumatic
brain injuries. 2
In all wars, healthy young people are trained
to effectively perform during violent,
chaotic assault but at the risk of lasting
psychological damage. To survive, they are
required to kill human beings never met; to
witness the violent death of comrades; to
withstand the loneliness of being continents
away from home, in an unsafe place, lacking
familiar food, customs or language; to
develop a keen awareness of risks both
physical (hyper-vigilance) and interpersonal
(avoidance, suspicion, distrust.)
These disorders as experienced among the
general public typically require professional
intervention, and if not arrested, can lead to
further complications such as abuse of
alcohol and other substances, un/underemployment, homelessness, health
problems, and death.
Key Differences About the Wars in Iraq
and Afghanistan
In the strange and dangerous realm of
combat, successful soldiers are trained to
depend on “War Zone Skills” 1. These are
based on an array of attitudes, beliefs and
practices that frequently require the soldier
The current wars in Iraq and Afghanistan are
distinctly different from all prior wars, in
ways that increase the risk of psychological
injury to veterans, as well as distress in their
families:
 No prior conflict has relied so
heavily on Reservists and National
Guardsmen as opposed to active duty
service members. Active duty
Authors: Arella & Rooney 11/11/09
* Veteran Family Support Alliance *
1








service members typically serve two
tours while reservists often serve
three or more.
There are no “battle lines”, hence
there are no “safe zones” either.
Since “battle lines” cannot be
determined, regulations which used
to reduce direct combat exposure for
women no longer apply.
We are now seeing the highest rates
(9:1) of wounded to killed in US
history.
Due to medical advances, far more
soldiers are surviving multiple
injuries, which frequently include
severe damage to the head, face and
extremities.
Survivors of physical injuries may
require multiple surgeries and years
of rehabilitation; many will have
irreversible deformities; some may
never again feel able to take up a
normal place in their families and
community.
Beginning with Viet Nam, media
coverage has been far more
immediate and extensive, which
tends to overload families back home
and creates a false sense of
connection between the soldier and
family; in reality, the longer the time
away, the more frequent the tours,
the farther apart they grow.
Cell phones and internet access
inside the war zone can confuse,
distract and overwhelm the soldier
who in previous wars needed only to
focus on the immediate orders and
needs of self and combat unit.
Studies of Post-WW II soldiers
found that only 25% of all soldiers
ever discharged their weapon in
combat. With advances in weapons
technology, weapons training,
dramatically different combat tactics
and multiple tours of active duty, the
Authors: Arella & Rooney 11/11/09

number of firings and kill rates for
today’s soldier far exceed those of
any prior war.
The return from the front to the
kitchen table has never been so
rapid. During the World Wars,
returning vets spent weeks on ships
with other soldiers, sharing
traumatic war experiences and
providing time for them to grieve
lost comrades and to share other
emotions. Today’s combatant can
often be home for dinner in 24 hours,
having neither time to grieve nor to
adjust to the very different role
expectations at home.
The Impact of War on Families
Support provided to military families varies
depending on whether the soldier is active
duty versus the Reserves and National
Guard. Families who live on military bases
are subject to constant reminders of what
loved ones risk in battle. For spouses and
children of soldiers there is the ever present
tension surrounding the coming and going of
one’s own soldier, along with the vicarious
loss experienced when parents and spouses
of classmates and neighbors do not come
back alive and whole. On the other hand,
families on military bases tend to understand
from the get-go about these risks, and they
have benefit of ongoing community support,
between and during leaves.
For many members of the Reserves and
National Guard, combat duty may never
have been seen as a possibility at the time of
enrollment. Families of the National Guard
and Reserves are not clustered on bases;
they are scattered throughout the country,
and are virtually invisible within their own
communities. This reduces opportunities for
mutual support as well as timely and
* Veteran Family Support Alliance *
2
accessible services for these military
families. Reservists often serve three or
more tours while soldiers in active duty
typically serve two.
Even if the soldier returns without
significant medical problems (hearing loss,
brain injury, ambulatory problems), the
potential for post-deployment job loss or
change is very real and adds to family
stress. This is especially worrisome for noncareer, military families. Whether soldiers
return to the same job, or find a new one,
reintegration to the civilian workforce will
be a difficult transition given the drastically
different social norms and structure in the
“war zone.”
While the veteran’s return means relief,
gratitude, and celebration, most families will
also experience significant post-deployment
distress. Even when soldiers return in good
physical and emotional condition, parents
and spouses often experience significant
grief over the young person who went to war
but is not the same upon return. After the
exhausting wait – for help with the children
and the bills and the chores – families may
experience frustration, resentment, and
impatience at how long it is taking for their
loved ones to “step up.” Many veterans
may, however, be intentionally holding back
from fully participating in order to not
disrupt the family. Having recently killed
and been exposed to many horrors, returning
combat veterans often see themselves as
“toxic” and may, as a result, attempt to
create emotional and physical distance from
loved ones.
Prior relationship expectations – of friend,
intimate partner, father – are likely to go
unmet for longer than the family
anticipated. The loneliness may feel even
more acute now that their loved ones are
home but continue to be emotionally
Authors: Arella & Rooney 11/11/09
detached and more dependent on comrades
than on family. The returning veteran may
unintentionally elicit fear, hurt, anger and
defiance by continuing to practice “war zone
skills” (e.g., cleaning guns when anxious,
insisting on absolute adherence to schedules,
yelling and ordering rather than instructing
and requesting.)
The soldier’s younger siblings or his/her
own older children may have taken on
additional responsibilities while the soldier
was away (such as watching out for younger
siblings or helping out with the family
business), tasks for which they are now
ridiculed for doing or from which they are
involuntarily retired. Younger children may
have grown up with so little actual contact
with the absent soldier to be unable to
establish close and trusting feelings toward
him or her. Children who were attached to
the parent pre-deployment often express
anger and ambivalence upon their return
because they have not been able to express
feelings of fear and abandonment about the
parent’s absence. Idealization – of the
innocent child back home that the soldier
imagined while in battle, and of the heroic
soldier the child longed for each night while
they were separated – now causes mutually
unmet expectations, disappointment, and
deep feelings of betrayal, hurt and
alienation.
On the whole, neither soldiers nor family
members are adequately prepared to expect
and understand the myriad emotions likely
to be experienced by each other, or the ways
in which each member has matured and
changed.
Living With An Emotionally Wounded
Soldier
All of these family dynamics are that much
worse when the returning soldier also suffers
* Veteran Family Support Alliance *
3
from depression and/or PTSD. The various
participants have a harder and harder time
with separations and reunifications because
of unresolved guilt, and unexpressed hopes
and fears. Conflicts tend to be more frequent
but less likely to be expressed in the open.
When conflicts do come to the fore, the
potential for malignant spirals and physical
danger, both actual and perceived,
increases. Inappropriate and unhealthy
coalitions form. Underlying relationship
problems (such as latent personality
disorders, tendency to abuse alcohol and
other substances, tolerance for disrespect
and aggression, enmeshment, partnership
ambivalence, communication deficits) are
magnified.
For returning veterans there are additional
factors to consider in assessing the severity
of these conditions, for the soldier and for
the family, post-deployment:




formal training in weaponry and selfdefense
characterological profiles associated
with domestic violence/batterers 3
how to distinguish “normative war
zone skills” from clearly
pathological indicators.
“Warrior Ethos” that can interfere
with self-identification and seeking
help 4
A Note To Families About How To
Prepare
It may take a long time for a loved one to
understand, accept, and forgive the soldier’s
decision to leave for war, risking injury and
death. There will be worse days and better
days for the families left behind. It will help
to be reminded that soldiers’ loved ones can
do things to help the soldier do his or her job
so they can come back home, alive and
Authors: Arella & Rooney 11/11/09
whole. Carrying unnecessary guilt and
worry about what will happen to the family
back home can only serve to distract the
soldier from doing what is necessary to
survive. Helping each family member to
handle themselves during painful and
stressful times will make a big difference for
everyone concerned.
It is important for family and other loved
ones to get information and support – if
possible, before deployment.
It is especially important to think about and
to plan for partings and returns. For
example, it is probably not a good idea to
bring the whole family for “a last goodbye”
at the airport just before take-off. Instead,
plan to spend the better part of the last day
or two at home together: avoid big parties,
complicated activities and public goodbyes.
Preferably before but at least immediately
after the soldier leaves, figure out where you
and your family can get support if needed.
Do attend seminars for pre- and postdeployment families made available through
the service branch and/or Veterans Services
Agency. If possible, get counseling going
for yourself and your children before the
veteran returns.
With a little searching, you are likely to find
a variety of services and programs that are
free of charge and specifically geared to the
needs and veterans and their families; some
also provide opportunities for family
members to volunteer or participate even
when the soldier is away from home. The
following are good places to locate
resources and support:

Family Readiness Groups (FRGs)
through the soldier’s branch of
service
* Veteran Family Support Alliance *
4



Military OneSource 800-342-9647
(www.militaryonesource.com)
Veteran Service Centers:
Eastern US: (800) 905-4675
Western US: (866) 496-8838

Veterans Families United Foundation













(www.veteransfamiliesunitedfoundat
ion.org)
The Veterans Administration
(www.va.gov)
New York State Division of
Veterans Affairs
(http://veterans.ny.gov)
Semper Fi Parents of the Hudson
Valley (www.semperfiparentshv.org)
The Soldiers Project
(www.thesoldiersproject.org)
Give An Hour
(www.giveanhour.com)
Local Departments of Mental
Hygiene, Family Services, United
Way
County-level Departments of Social
Services
State-Level Psychological
Association (in New York:
www.nyspa.org)
View the following pamphlet online: What
Families should Know and What Families
Can Do 5 (Rand Corp.)
Know The Signs of Emotional Distress
It is helpful for families to be able to
recognize a variety of behaviors associated
with Depression, Anxiety and PTSD. The
following can be subtle but meaningful signs
of emotional distress – for the veteran or
family member:



Social withdrawal
Avoiding certain situations
Changes in eating habits
Authors: Arella & Rooney 11/11/09


Irritability, short temper, mood
swings
Tearfulness, hopelessness
Excessive reliance on self-soothing
behaviors
Nightmares
Problems falling asleep
Excessive sleep
Unexplained absences
Unexplained disappearance of
money
Suicidal thoughts, self-injury and harm to
others are never acceptable. These should
all be discussed with a qualified mental
health professional for immediate
assessment.
Other symptoms that should not be ignored
include property damage (example:
punching walls), substance abuse (including
drunkenness, prescription medications or
illegal drugs), and symptoms of posttraumatic stress disorder (exaggerated startle
response, flashbacks, intrusive and
unwanted thoughts.)
Reuniting with and reintegrating the family
is stressful and can take months or longer.
While celebration is appropriate, it is
important to focus first on the needs of the
soldier and immediate family and to delay
big parties and demanding activities, at least
in the beginning. The family needs to have
time to be reacquainted privately. It is
probably not a good idea to meet a vet at the
base upon discharge but to arrange for a
small and private welcome at home.
If psychological problems emerge, offer to
participate in therapy with the veteran, as
long as this would not cause further harm to
a family member. Social support is
especially powerful therapy: encourage
veterans to stay in touch with service-related
organizations and friends, even if that means
* Veteran Family Support Alliance *
5
they are not home as much.
Shame is the biggest obstacle to seeking
treatment – be clear, calm, concerned and
persistent about getting whatever your
family needs to adjust and to heal, but avoid
embarrassing, humiliating, coercing,
threatening or bullying people to participate
in therapy.
Promote The Belief That Veterans
Deserve and Benefit From Treatment:
A Special Word For Mental Health
Professionals
Clearly, there is a growing need for mental
health treatment on behalf of returning
warriors and their families. The demand for
treatment, among those affected by the
recent wars in Iraq and Afghanistan, is likely
to continue for decades to come. It is the
authors’ hope that this article will inspire
many colleagues to take up this important
work.
However, we also believe that, in order to
provide the greatest benefit and the least risk
of harm to military families, these families
must be treated as a “special population.”
Whether explicit or implicit, all mental
health professionals are obliged to provide
appropriate care, which includes addressing
treatment groups and issues about which one
is adequately trained. As such, if you plan
to work with military families but have no
first hand combat experience, it is
incumbent upon you to learn as much as you
can about military procedure, structure and
culture. Having contact information and
access to local resources and benefits for
military families (example, VA, VSA) is
also important.
very clear about how you work, what you
plan to focus on, limits of confidentiality,
etc. It is essential that you be able to set
aside judgments, assumptions and opinions
you may hold about warfare and about
military culture so that you can truly listen
to each veteran’s unique story, honor each
family’s unique history and aspirations, help
each case discover its own, unique path to
recovery and growth.
It is especially important to differentiate
learned “war zone” behaviors from more
serious indicators of underlying pathology.
The following is a most useful review and is
available on the internet: Behaviors of
Veteran Readjustment Problems and the
Impact to Family/Friends 6 It is equally
important that the professional accurately
identifies and addresses truly pathological
and/or dangerous patterns of behavior such
as those that have been consistently found to
be associated with domestic violence.7
When you meet a soldier, thank him or her
for their service to their country. Ask about
which branch of service they joined, where
they were based, where they were assigned
to duty. Add military background questions
to your standard intake protocol. Provide a
safe place where they can tell their story. It
will help to receive training in EMDR or
other evidenced-based treatment for
Combat-related PTSD. Help military
families access your services by joining
Tricare, the medical insurance plan for
military personnel. Volunteer time: contact
www.TheSoldiersProject.org, or
www.GiveanHour.org.
You will need to be ready to provide a
veteran-friendly treatment environment from
the very first contact. It is important to be
Authors: Arella & Rooney 11/11/09
* Veteran Family Support Alliance *
6
Footnotes
1, 6. Behaviors of Veteran Readjustment
Problems and the Impact to Family/Friends.
www.VeteransFamiliesUnitedFoundation
.org See also
www.hooah4health.com/deployment;
www.militaryonesource.com
2. T.Tanielian and L.Jaycox, Eds. (2005)
Invisible Wounds of War. Rand Center for
Military Health Policy Research.
3., 7 L. Bancroft (2002) Why Does He DO
That? Berkeley Book Company.
4. Geraci, J. MAJ (2009) The Challenges
of Help-Seeking. West Point Behavioral
Health and Resilience Conference: Sept.
5. Post-Deployment Stress: What Families
Should Know and What Families Can Do.
(2008) Rand Center for Military Health
Policy Research. (Rand Corp.)
Acknowledgements
This article was originally published on the
website of the New York State Psychological Association (NYSPA), in connection
with public education activities on Veterans
Day, 2009.
The authors wish to thank members and
supporters of the Veteran Family Support
Alliance (formerly the Hudson Valley
Veterans Project Planning Group), and
for the inspiring presentations at
NYAMFT’s November 8, 2009 Conference
entitled “A Warrior’s Return” by Jemal
Doute, MA, Rev. Sean Levine, Eva J. Usadi,
MA, and Susan Blum, MD.
For More Information, Please Contact:
Lorinda R. Arella, Ph.D., Chair
Veteran Family Support Alliance (VETFAMSA)
About the Authors:
Authors Arella and Rooney are both
members of NYSPA and of the Hudson
Valley Psychological Association.
Dr. Lorinda R. Arella is a NYS Licensed
Psychologist in private practice in Dutchess
County, New York. The early part of her
career was devoted to developing and
evaluating drug treatment rehabilitation
programs in New York City, at a time when
many of the more severe cases in publicly
funded treatment programs were Vietnam
veterans. She currently specializes in
adolescents, trauma, and court-mandated
families. In Summer 2009, she began and
currently chairs the VETFAMSA (Veteran
Family Support Alliance), a multidisciplinary grassroots coalition working to
promote access to mental health and other
services for veterans and their families in the
Hudson Valley.
Dr. Rebecca Rooney is a retired Army
Lieutenant Colonel, a NYS Licensed
Psychologist and active member of
VETFAMSA. During her 23 years of
military service, she served the in the fields
of Military Intelligence, Personnel
Management and Psychology. She
commanded three units and served in
Battalion, Division, Major Command, and
Army level staff positions. Her Psychology
experience in the military includes work
with West Point cadets, and serving in Staff
Psychology and Drug and Alcohol
positions. She has treated soldiers, their
spouses, and veterans of World War II, the
Gulf War, and Vietnam Conflict, and the
current conflict in Iraq. She is currently in
private practice in Orange County, New
York.
[email protected] (845) 226-4218
Authors: Arella & Rooney 11/11/09
* Veteran Family Support Alliance *
7